Treatment of Premature Ventricular Complexes

Premature ventricular complexes, or PVCs, are among the most common of the cardiac arrhythmias. Unfortunately, their medical significance — and therefore their treatment — is often confusing to many healthcare providers and patients.

If you have PVCs, your treatment should depend on the answer to two questions:

First, do you have underlying heart disease?

And second, how severe are the symptoms produced by the PVCs?

PVCs themselves are rarely dangerous. While statistically PVCs are associated with an increased risk of dying, that increased risk is mainly due to the presence of underlying heart disease and to risk factors for cardiac disease. The PVCs themselves, in general, are thought to be largely benign.

The First Treatment Goal: Reduce Cardiac Risk

Because PVCs are often associated with underlying heart disease, your healthcare provider should perform a cardiac evaluation when he or she first discovers them.

If it turns out that you have heart disease, adequate treatment of your cardiac condition will often eliminate or reduce the frequency of PVCs. This is especially true if you have coronary artery disease (CAD) or heart failure.

In some rare individuals, extremely frequent PVCs are now thought to be responsible for producing cardiomyopathy (weak heart muscle).

As a result, if unexplained cardiomyopathy is found in the presence of very frequent PVCs, it may be helpful to treat the PVCs to see if the cardiomyopathy improves.

If your healthcare provider finds your heart to be healthy, that's a very good thing. However, PVCs are also associated with several risk factors for CAD, especially hypertension. Non-CAD risk factors for PVCs also include hypomagnesemia (low magnesium) and hypokalemia (low potassium).

The Second Treatment Goal: Reduce Symptoms

Fortunately, most people who have PVCs do not "feel" them at all. However, some perceive their PVCs as palpitations, which they usually describe as "skips" or "pounding" that can vary from mildly annoying to extremely disturbing.

So, in addition to doing an evaluation for heart disease, sometimes it is necessary to consider doing something about the PVCs themselves in order to reduce symptoms.

The treatment of PVCs would be easy if we had antiarrhythmic drugs (drugs that treat cardiac arrhythmias) that were both safe and effective at getting rid of PVCs. Unfortunately, this is not the case. So deciding whether to treat PVCs and how to treat them is often more difficult than you might think.

If your PVCs are not causing symptoms, or if the palpitations you experience are not troublesome to you, the best thing to do is usually to leave them alone. However, if your PVCs are causing palpitations sufficient to disrupt your life, then you and your healthcare provider should discuss the options for treating PVCs.

First, you should try eliminating caffeine from your diet. In people who are sensitive to it, caffeine can increase the frequency of PVCs. The same thing goes for tobacco products and alcohol—eliminate these from your diet also.

There's also evidence that regular exercise can reduce palpitations. So if you have been relatively sedentary, talk to your healthcare provider about beginning an exercise program.

If you have made these kinds of lifestyle changes and are still troubled by the symptoms of PVCs, you and your healthcare provider may want to consider a trial of drug therapy.

If you opt for drug therapy, it is usually a good idea to start with a trial of beta blockers—drugs that blunt the effect of adrenaline. Beta blockers are not as effective as "true" antiarrhythmic drugs at eliminating PVCs, but they are generally safe and usually well tolerated. While they may reduce the PVCs themselves, beta blockers work better at reducing the symptoms PVCs cause.

The more powerful antiarrhythmic drugs are often reasonably effective at suppressing PVCs. However, these drugs are prone to cause significant problems. Chief among them is a tendency to cause "proarrhythmia"—that is, actually triggering arrhythmias that may be far more dangerous than the PVCs. Proarrhythmia is particularly likely in people who have underlying heart disease, but it can happen to anyone. In addition, each antiarrhythmic drug has its own unique toxicity profile that renders this class of drugs among the most toxic used in medicine.

Finally, in patients whose PVCs are extremely disturbing and cannot be safely treated with lifestyle changes or drugs, it may be possible for an electrophysiologist to treat them with ablation therapy —electrically mapping the location that is producing the PVCs and cauterizing it with a special cardiac catheter.

A Word From Verywell

Because PVCs themselves are usually not dangerous, the aggressiveness applied to their therapy should be based almost completely on how much the PVCs are disrupting your life. While it is fortunate that PVCs usually cause only minimal symptoms, that fact doesn't help very much if you are one of the unlucky few whose PVCs are highly bothersome. In this case, you will need to find a knowledgeable and sympathetic healthcare provider who can help you go through all the treatment options and devise a strategy that is right for you.